BACKGROUND: Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children. METHODS: We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels. FINDINGS: We included 35 countries with surveys done an average of 9·1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles. INTERPRETATION: Equity should be accounted for when planning the scaling up of interventions and assessing national progress. FUNDING: Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK.
BACKGROUND: Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children. METHODS: We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels. FINDINGS: We included 35 countries with surveys done an average of 9·1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles. INTERPRETATION: Equity should be accounted for when planning the scaling up of interventions and assessing national progress. FUNDING: Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK.
Authors: Maximiliane L Verfürden; Tiffany Fitzpatrick; Laura Holder; Ania Zylbersztejn; Laura Rosella; Ruth Gilbert; Astrid Guttmann; Pia Hardelid Journal: CMAJ Open Date: 2020-04-28
Authors: Ma del Carmen Casanovas; Chessa K Lutter; Nune Mangasaryan; Robert Mwadime; Nemat Hajeebhoy; Ana Maria Aguilar; Ciro Kopp; Luis Rico; Gonzalo Ibiett; Doris Andia; Adelheid W Onyango Journal: Matern Child Nutr Date: 2013-09 Impact factor: 3.092
Authors: Joel D Bognini; Sekou Samadoulougou; Mady Ouedraogo; Tiga David Kangoye; Carine Van Malderen; Halidou Tinto; Fati Kirakoya-Samadoulougou Journal: Int J Equity Health Date: 2021-05-21
Authors: Elysia Larson; Daniel Vail; Godfrey M Mbaruku; Redempta Mbatia; Margaret E Kruk Journal: Int J Qual Health Care Date: 2017-02-01 Impact factor: 2.038
Authors: Kimberly Peven; Lindsay Mallick; Cath Taylor; Debra Bick; Louise T Day; Lionel Kadzem; Edward Purssell Journal: Int J Equity Health Date: 2021-06-05